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Tuesday 20th November 2018


08.30-09.30

Registration

09.30-11.00

BAPEN Opening Symposium

Topic: The Failing Gut

Location:    Auditorium   

Ella Terblanche

Presentation title: Nutrition support in the ischaemic abdominal catastrophe

  1. Patients who experience ischemic abdominal catastrophes will be nutritionally complex requiring frequent reviews to alter nutritional plans over the course of ICU stay to match the metabolic phase of critical illness & disease progression.
  2. A collaborative multi-professional approach is needed for optimal nutritional treatment whilst critically ill.
  3. Patients who experience ischemic abdominal catastrophes will often end up nutritionally and physically wasted after prolonged ICU stays and therefore ongoing nutritional rehabilitation & optimisation is essential.

11.00–11.30

Coffee & Exhibition

11.30-13.00

Symposium 1

Topic: Home Enteral Tube Feeding

Location:    Auditorium   

Dr Sarah Durnan

Presentation title: ‘It’s Just Food Blended’: Exploring Parents’ Experiences of Choosing Blended Diet for Their Tube-fed Child

  1. Wider concern for the health and safety of their child such as recurrent aspiration pneumonia due to perceived feed intolerance or risk of anti-reflux surgery drives parents’ decision making about blended diet and should be considered by professional as part of any holistic risk assessment.
  2. This research suggests blended diet can have an almost immediate improvement in symptoms commonly associated with tube feeding intolerance. In addition, parents associated the transition to blended diet with improvements in general health and wellbeing of the child.
  3. Parents perceive commercial formula to be medicine rather than food. Use of blended diet can provide a feeling of normalisation for parents, include the tube-fed child in social events centred on food and have a positive impact on wider family life.

Anne Mensforth

Presentation title: Home Nasogastric feeding – dilemmas and developments

  1. Should we utilise nasogastric feeding for adults in the community more frequently?
  2. What are the obstacles to the use of nasogastric feeding at home?
  3. What developments are needed to make nasogastric feeding safer?

Gareth Bastable

Debate: Home Enteral Feeding Hot Topics

  1. I do not see myself as an adult or paediatric dietitian. I am a Home Enteral Feeding Dietitian. I believe home enteral feeding is a specialty all in itself.
  2. We need to keep our minds open to new ideas and initiatives within Home Enteral Feeding. Our patients carers and parents quickly become experts in the practicalities of living with tube feeding and we need to listen to what they are telling us.
  3. More research or national consensus is needed within Home Enteral Feeding.

Symposium 2

Topic: Information Technology for Nutrition Support

Location: Queens Suite 1

Dr Mohammad Al-Ubaydli

Presentation title: Linking patients on home parenteral nutrition to the nutrition team

  1. Complex conditions need integrated care and engaged patient.
  2. True patient portal critical to engage patient and engage care.
  3. PKB patient portal is already live and working across the UK.

Carola McKenna

Presentation title: Developing electronic prescribing, for parenteral nutrition, using the Epic system.

  1. The implementation of a new electronic prescribing system that has the ability to prescribe parenteral nutrition in a completely electronic way is an amazingly powerful tool.
  2. It is very difficult to assign strict mathematics and rules to a historically flexible field of prescribing. The prescribing of parenteral nutrition in the USA is different to conventions in the UK. The system has is restrictive in ways I hadn’t appreciated but equally has extensive functionality that is underused.
  3. We are only at the very start of our journey using electronic prescribing for parenteral nutrition. The project doesn't go live until next year. I am sure there will be unexpected hiccups along the way, but the I am excited about the future of prescribing of parenteral nutrition electronically.

Symposium 3

Topic: Implementation and Monitoring of Standards for Nutrition Support

Location: Queens Suite 2

Dr Alastair McKinlay

Presentation title: The Scottish Complex Nutritional Care standards

  1. Standards and Guidelines are different. Standards can have a long working life if drafted carefully.
  2. Standards are more effective if they monitored.
  3. Standards can act as a reference to allow other forms of change to be introduced.

Amelia Jukes

Presentation title: Standardising Nutrition Screening – an All Wales Approach

  1. Screening for malnutrition risk is recognised as the essential first step in identifying people who may benefit from interventions and support to mitigate or manage nutritional risk, improving patient well being and clinical and organisation outcomes including reducing admissions and length of stay.
  2. No one tool is perfect and applicable to all patient groups as well as predictors of poor nutrition-related outcomes.
  3. Standardising the screening tool used will permit standardised recording of risk. Electronic adaptation should enable auditing and benchmarking.

13.00-14.30

Lunch, Exhibition & Chaired Posters
   Auditorium    BAPEN AGM

14.30-16.00

Symposium 4

Topic: Gastrophysics and the “shape” of Food – a way forward to tackle malnutrition

Location:    Auditorium   

Jozef Youssef

Presentation title: Eating with your mind

  1. Flavour is a multisensory construct of the mind rather than a simple sensory perception involving smell and taste
  2. We all live in separate taste worlds both physiologically and psychologically. No two people can perceive/judge flavour in the same way.
  3. Can an understanding of our sensory relationship with food aid us in designing experiences (in homes, schools, care homes and hospitals) which encourage individuals (of all ages) to make more nutritious and sustainable food choices.

Prof Alan Mackie

Presentation title: The role of food structure in lowering risk factors for metabolic disease

  1. Both food structure and composition are important in our interactions with food at different levels, many of which we are unaware of. In particular the structuring of food in the stomach can alter appetite and nutrient absorption kinetics.
  2. Nutrient density is an important factor in appetite regulation but is often difficult to manipulate because of adverse effects on organoleptic properties of food. In other words increasing the dietary fibre in foods and make them more satiating but less palatable.

Dr Karen Freijer

Presentation title: The health and economic value of optimal nutrition on disease-related malnutrition

  1. Nutrition is a science and not a hobby. Multidisciplinary approach for optimalisation of nutrition is needed.
  2. Optimal nutrition can save a lot of money while improving quality of life.
  3. Investing in optimal nutrition should be standard before spending money on symptomatic treatment.

Symposium 5

Topic: Palliative Care and PN

Location: Queens Suite 1

Dr Mani Naghibi

Presentation title: When to start and when not to start palliative HPN

  1. MDT approach to deciding with patient regarding commencing HPN in advanced incurable malignancies.
  2. Prognostic score can add information to the decision, but performance status and social support structure remain more important coupled with clinical judgement.
  3. Lack of clarity in international guidelines remain due to variable practices and attitudes across the world.

Symposium 6

Topic: Nasogastric tube safety: what’s all the “pHuss” about

Location: Queens Suite 2

Workshop

Topic: Write for Publication (Limited to 30 places)

Location:      HCC Suite     


16.00-16.30

Tea & Exhibition

16.30-17.30

Pennington Lecture

Topic: “You Can Do It!”

Location:    Auditorium   

   Auditorium    BAPEN 2018 Recognition & Awards

17.30-18.30

Satellite Symposia

Satellite Symposium

Topic: Bolus Feeding

Location: Queens Suite 1

Abbott logo

Satellite Symposium

Topic: Short Bowel Syndrome Intestinal Failure

Location: Queens Suite 2

Shire logo

Speakers:


Wednesday 21st November 2018


07:00-08:30

Breakfast Symposium

Topic: Optimising the Management of Disease Related Malnutrition

Location: Queens Suite 2

Nutricia logo

08.30-09.30

Registration

09.00-10.30

Symposium 7

Topic: Prehabilitation: Getting fit for Surgery

Location:    Auditorium   

Prof Peter Soeters

Debate: Do all surgical patients benefit from preoperative nutritional optimisation

  1. To raise an adequate healing response, the body must be insulin resistant. Insulin resistance results from inhibition of glucose oxidation and glucose utilization for glycogen synthesis; and from increase new formation of glucose. This increases glucose levels and keeps glucose available as building stones for synthesis of immune cells, synthesis of wound cells and matrix. These anabolic functions are stimulated at higher glucose levels.
  2. Well-nourished individuals in good shape do not benefit from preoperative support. The benefit of omega-3 FA enriched nutritional supplements is doubtful and may at best be minor. Preoperative nutritional support of severely ill (infected) patients is damaging, if delaying treatment of infection. If treatment can only be achieved by surgery, it should be performed immediately after restoring cardiovascular and respiratory stability including covering electrolytes, micronutrients etc. The surgery should be defensive, not creating hazardous anastomoses or performing extensive oncologic surgery. It is becoming likely that postoperative nutritional support should not be forcefully implemented.
  3. The rare patient that is malnourished purely on the basis of starvation, may benefit from establishing hemodynamic stability, replenishing deficiencies of electrolytes, micronutrients, vitamins etc deficiencies in a few days, but repleting muscle mass takes weeks or months.

Symposium 8

Topic: Venous Access

Location: Queens Suite 1

Dr Geert Wanten

Presentation title: Arteriovenous fistulae as venous access in HPN

  1. AVFs are a safe option to deliver long-term HPN, especially in high infection risk patients.
  2. Not for everyone (require (self)puncturing, vessel quality).
  3. Occlusion is an issue: maintenance required.

Joe Colby

Presentation title: Counselling for patients with Intestinal Failure

  1. There is very little formal provision for psychological services for IF patients.
  2. Patients need people to support them who have knowledge of their condition.
  3. The Nutrition team MDT is the greatest counselling / support service although individual members may not have any formal training.

Carolyn Wheatley

Presentation title: Do we align with patient expectations?

  1. Think about the ‘person’ into whom the line is being placed.
  2. Your actions may impact their quality of life.
  3. If we believe it should be ‘no decision about me without me’ does that translate into practice?

Winifred Magambo-Gasana

Presentation title: Line Selection

  1. There are different types of vascular access devices that can be used for mid-long term Parenteral Nutrition.
  2. Peripherally Inserted Central Catheters (PICCs) can safely be inserted and tip position confirmed by the bedside and used for parenteral nutrition.
  3. Power injectable vascular access devices are available both as peripheral and central devices and can be used for parenteral nutrition

Symposium 9

Topic: Sugar

Location: Queens Suite 2

Sally Moore

Presentation title: Dietary sugar: Definitions and labelling issues

  1. New guidance on the definition and recommended intake of “free sugars” is available in the UK.
  2. Content of total sugars rather than those which are added or “free” is currently displayed on UK nutrition labels.
  3. Health professionals can support consumers to use nutrition information and understand sugar recommendations.

Dr Bernadette Moore

Presentation title: How to reduce sugar - do taxes work?

  1. A systemic, sustained portfolio of initiatives, delivered at scale, is needed to address the health burden of obesity.
  2. Sugar and energy reduction and reformulation of foods important component, but other actions required as well.
  3. Sugar taxes can be beneficial but cannot solve obesity alone.

Workshop

Topic: Write for Publication (Limited to 30 places)

Location:      HCC Suite     


10.30-11.00

Coffee & Exhibition

11.00-12.30

Symposium 10

Topic: Invasive Access for Enteral Nutrition

Location:    Auditorium   

Dr Laurence Lacaze

Presentation title: Distal feeding, is it worth the effort?

  1. Indication of distal feeding is type 2 intestinal failure in patients with double enterostomy or enterocutaneous fistula. It is safe if the dedicated protocol is respected.
  2. Distal feeding improves nutritional status, liver function, decrease of fistula output. It could replace parenteral nutrition and had a lower cost.
  3. Distal feeding is a part of intestinal rehabilitation. It needs a muldisciplinary team to perform enteroclysis or chime reinfusion.

Symposium 11

Topic: Nutrition and Liver

Location: Queens Suite 1

Dr Matthew Armstrong

Presentation title: Decompensated liver disease – how do we manage the inpatient nutritional needs

  1. Malnutrition and frailty is extremely common in end-stage liver disease, and should routinely be assessed using standardised anthropometry (hand grip strength, tricep skin fold thickness etc) and functionality tests, respectively.
  2. Achieving optimal protein requirements (1.5g/kg/day) is critical in patients with end-stage liver disease and have a low threshold for establishing enteral feeding if poor oral intake.
  3. Improving the nutritional status and frailty in a patient with end-stage liver disease improves quality of life, reduces complications of liver disease (i.e. ascites) and reduces the risk of death in patients pre and post liver transplant.

Dr Darren Wong

Presentation title: Deranged liver function tests in patients with parenteral nutrition – commonly encountered challenges

  1. Don’t always blame the parenteral nutrition.
  2. Always look for sepsis as a cause for abnormal LFT.
  3. An excess of any of the macronutrient components of PN can be hepatotoxic.

Symposium 12

Topic: Optimising Care of Malnourished Patients: Latest evidence and practice

Location: Queens Suite 2


12.30-14:00

Lunch, Exhibition & Chaired Posters
   Auditorium    BAPEN Medical AGM
Queens Suite 1 PENG AGM

14.00-15.00

Keynote Lecture

Topic: Drug-Nutrition Interaction in Nutrition Support

Location:    Auditorium   

Prof Joseph Boullata

Presentation title: Drug-Nutrition Interaction in Nutrition Support

  1. The term drug-nutrition interaction is broad and reflects a physical, chemical, physiologic, or pathophysiologic relationship between a medication and a nutrient, a meal, specific foods or food components, metabolic status, or nutrition status. Some of these interactions may be of concern in patients receiving nutrition support.
  2. The stability, compatibility, and bioavailability of medication with PN admixtures or with EN formulas is important to appreciate whether combined or administered concurrently.
  3. The clinician’s role in identifying and managing drug-nutrition interactions can include participation to improve policies & procedures, encourage integrated decision support systems, and maintain thorough evidence-based practices to assess the patient and their nutrition support regimen.

15.00-16.00

Symposium 13

Topic: Hot Topics in Clinical Nutrition

Location:    Auditorium   

Pete Turner

Presentation title: All surgical patients benefit from preoperative nutritional optimisation

  1. Improvements in energy stores as well as micronutrient and electrolyte status can be achieved in the short term but requires the provision of balanced nutrition to do so.
  2. It is better to provide nutrition before the metabolic insult of surgery which will impair the effective use of nutritional substrates.
  3. Having surgery in the starved state increases postoperative muscle catabolism, leading to decreased muscle strength and impaired rehabilitation.

16.00

   Auditorium    Close of Conference


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